Defining a Research Agenda for Layperson Prehospital Hemorrhage Control: A Consensus Statement

Eric Goralnick, Chibuike Ezeibe, Muhammad Ali Chaudhary, Justin McCarty, Juan P Herrera-Escobar, Tomas Andriotti, Elzerie de Jager, Daniel Ospina-Delgado, Craig Goolsby, Richard Hunt, Joel S Weissman, Adil Haider, Lenworth Jacobs, Stop the Bleed National Research Agenda Consensus Conference Working Group; Erin Andrade, Jeremy Brown, Eileen M Bulger, Frank K Butler, David Callaway, Edward J Caterson, Niteesh K Choudhry, Michael R Davis, Alex Eastman, Brian J Eastridge, Jonathan L Epstein, Conor L Evans, Marianne Gausche-Hill, Mark L Gestring, Scott A Goldberg, Dan Hanfling, John Bradley Holcomb, Carl-Oscar Jonson, David R King, Sean Kivlehan, Russ S Kotwal, Jon R Krohmer, Nomi Levy-Carrick, Matthew Levy, Joan José Meléndez Lugo, David P Mooney, Matthew D Neal, Robert Niskanen, Patrick O'Neill, Habeeba Park, Peter T Pons, Erik Prytz, Todd E Rasmussen, Michael A Remley, Robert Riviello, Ali Salim, Stacy Shackelfold, E Reed Smith, Ronald M Stewart, Mamta Swaroop, Kevin Ward, Tarsicio Uribe-Leitz, Molly P Jarman, Gezzer Ortega

JAMA Netw Open. 2020 Jul 1;3(7):e209393

Importance: Trauma is the leading cause of death for US individuals younger than 45 years, and uncontrolled hemorrhage is a major cause of trauma mortality. The US military's medical advancements in the field of prehospital hemorrhage control have reduced battlefield mortality by 44%. However, despite support from many national health care organizations, no integrated approach to research has been made regarding implementation, epidemiology, education, and logistics of prehospital hemorrhage control by layperson immediate responders in the civilian sector.

Objective: To create a national research agenda to help guide future work for prehospital hemorrhage control by laypersons.

Evidence review: The 2-day, in-person, National Stop the Bleed (STB) Research Consensus Conference was conducted on February 27 to 28, 2019, to identify and achieve consensus on research gaps. Participants included (1) subject matter experts, (2) professional society-designated leaders, (3) representatives from the federal government, and (4) representatives from private foundations. Before the conference, participants were provided a scoping review on layperson prehospital hemorrhage control. A 3-round modified Delphi consensus process was conducted to determine high-priority research questions. The top items, with median rating of 8 or more on a Likert scale of 1 to 9 points, were identified and became part of the national STB research agenda.

Findings: Forty-five participants attended the conference. In round 1, participants submitted 487 research questions. After deduplication and sorting, 162 questions remained across 5 a priori-defined themes. Two subsequent rounds of rating generated consensus on 113 high-priority, 27 uncertain-priority, and 22 low-priority questions. The final prioritized research agenda included the top 24 questions, including 8 for epidemiology and effectiveness, 4 for materials, 9 for education, 2 for global health, and 1 for health policy.

Conclusions and relevance: The National STB Research Consensus Conference identified and prioritized a national research agenda to support laypersons in reducing preventable deaths due to life-threatening hemorrhage. Investigators and funding agencies can use this agenda to guide their future work and funding priorities.